Pathophysiology, evaluation, and management of malnutrition in hematologic malignancies: a comprehensive review

Hematologic malignancies are frequently complicated by malnutrition, a condition that remains underrecognized yet strongly associated with impaired treatment tolerance, immune recovery, and survival. Unlike solid tumors, hematologic malignancies are characterized by diffuse marrow and immune system involvement, rendering host metabolism highly vulnerable to tumor-driven inflammation and therapy-induced immune stress. Accumulating evidence indicates that nutritional deterioration in hematologic malignancies reflects a state of integrated immunometabolic vulnerability—driven by hyperinflammation, anabolic resistance, gastrointestinal injury, and psychosocial stress—rather than inadequate caloric intake alone. This review synthesizes current evidence on the biological basis, clinical assessment, and management of malnutrition in hematologic malignancies, with particular emphasis on hematopoietic stem cell transplantation and cellular therapies. We propose that nutritional care in hematologic malignancies should evolve from supportive supplementation toward mechanism-informed, precision nutritional strategies aimed at modulating host metabolism and immune function to improve clinical outcomes.